Provider Demographics
NPI:1861822694
Name:GALLOWAY, DARLENE
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-2805
Mailing Address - Country:US
Mailing Address - Phone:336-264-2862
Mailing Address - Fax:336-342-2783
Practice Address - Street 1:109 ROANOKE ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-3023
Practice Address - Country:US
Practice Address - Phone:336-349-4255
Practice Address - Fax:336-342-2783
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility